Provider Demographics
NPI:1457307241
Name:LAWSON, THEODORE S (MD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:S
Last Name:LAWSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3470 CENTENNIAL BLVD STE 210
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-4090
Mailing Address - Country:US
Mailing Address - Phone:719-955-0707
Mailing Address - Fax:719-495-7333
Practice Address - Street 1:3470 CENTENNIAL BLVD STE 210
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-4090
Practice Address - Country:US
Practice Address - Phone:719-955-0707
Practice Address - Fax:719-495-7333
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO36604207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01366046Medicaid
COG68229Medicare UPIN
CO01366046Medicaid